Subject(s)
Colonic Pouches/adverse effects , Postoperative Complications/etiology , Proctocolectomy, Restorative/adverse effects , Adult , Colitis, Ulcerative/surgery , Colorectal Neoplasms/surgery , Female , Follow-Up Studies , Humans , Laparoscopy/methods , Middle Aged , Postoperative Complications/surgery , Prolapse , Reoperation , Suture Techniques , Time FactorsABSTRACT
Initial implementation and maintenance of an enhanced recovery protocol (ERP) is complex and has not been adequately described. The aim of this study was to investigate the efficacy of an ERP at a tertiary care academic institution. A secondary aim was to identify barriers to implementation and continued protocol compliance (PC) to further decrease length of stay (LOS). Patients undergoing colon resection from February 2, 2011 to December 19, 2014 were compared with patients that followed implementation of an ERP from August 10, 2015 to July 14, 2016. The primary endpoint was LOS. Secondary endpoints were PC, analgesia requirements, time to return of bowel function, and ileus. One hundred and seventy-seven historical controls were compared with 68 ERP patients. LOS was shorter in study patients (4.9 vs 7.1 days for open surgery; 3.3 vs 6.1 for laparoscopic surgery). Intraoperative IVF balance, morphine equivalents, and length of time to return of bowel function were significantly less in the ERP group (1445.89 ± 845.25 mL vs 3006.08 ± 1197.97 mL), (64.48 ± 114.49 vs 232.90 ± 541.47), (2.41 ± 1.32 days vs 3.82 ± 2.00 days). Rate of ileus was less in study patients (4.8 vs 14.7%). The readmission rate and 30-day National Surgical Quality Improvement Program complication rates were not significantly different. PC was negatively associated with LOS (r = -0.35, P = 0.0026). Similar to prior studies, this study demonstrates the efficacy of an ERP. Increased PC is associated with decreased LOS, thus providing further evidence that ERPs should be the standard of care. Scheduled interdisciplinary meetings to discuss patient outcomes and methods to increase PC can help further improve efficacy of ERPs.
Subject(s)
Colectomy/adverse effects , Colonic Diseases/surgery , Guideline Adherence , Length of Stay , Postoperative Care , Postoperative Complications/epidemiology , Adult , Aged , Aged, 80 and over , Colonic Diseases/pathology , Female , Humans , Male , Middle Aged , Patient Readmission , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Practice Guidelines as Topic , Recovery of Function , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Intrapancreatic enteric duplication cysts are exceedingly rare, and the clinical presentation varies. We present a 48-year-old man with significant alcohol and tobacco abuse and a diagnosis of groove pancreatitis complicated by a pancreatic duct stricture, pseudocyst, and recurrent biliary obstruction. Due to failure of endoscopic therapy and concerning findings on endoscopic ultrasound with negative pathology, he underwent a pancreaticoduodenectomy. Pathology revealed an intrapancreatic enteric duplication cyst, minimal chronic pancreatitis changes associated with pancreaticobiliary strictures, and no evidence of malignancy. This rare diagnosis should be considered in the differential for patients with idiopathic recurrent pancreaticobiliary duct strictures and pancreatic pseudomasses.
